<?php
	session_start();
	require('include/inc.start.php');
?>
<!DOCTYPE html PUBLIC "-//W3C//DTD XHTML 1.0 Transitional//EN" "http://www.w3.org/TR/xhtml1/DTD/xhtml1-transitional.dtd">
<html xmlns="http://www.w3.org/1999/xhtml">
<head>
	<meta http-equiv="Content-Type" content="text/html; charset=iso-8859-1" />
	<title>Registration with Getub</title>
	<?php include ('common_head.html');?>
	<?php include ('register_head.html');?>
	<?php include("include/setupMail.php"); ?>
	<script type="text/javascript">
	jQuery(document).ready(function(){
		jQuery(function(jQuery){
			jQuery("#phone").mask("(999) 999-9999");
		});
	});
	</script>
</head>

<body>
<?php include ('login.php');?>
<div class="back">
  <div class="footerBg">
  <div id="frame">
<!-- will need to use "target="_blank" to show lightbox confirmation -->
<form id="registerForm" name="registerForm" method="post" action="register.php">
 <?php include("include/postdata.php"); ?>
  
  <?php include ('header.php');?>
  <div class="mainfrm">
  <div class="bluestripfrm">
  <div class="regwith"></div>
  </div><!--bluestripfrm-->
  
<!-- pst data php used to be below here -->

  <div class="formframe">
  <div class="formheading1"></div>
  
  <div class="formsection">
   <div class="formrowrg">
  <div class="fieldfrm">
  <div class="textboxfrm"><span class="label">First Name<span style="color:#FF9000">* </span></span><span class="left"></span><span class="center">
      <input class="textbox required validate-alpha" id="firstName" name="firstName" type="text" style="width:260px;"  maxlength="35" />
   </span><span class="right"></span> </div>
    </div><!--fieldfrm-->
	
  <div class="fieldfrm">
  <div class="textboxfrm"><span class="label">Last Name<span style="color:#FF9000;">* </span></span><span class="left"></span><span class="center"><input class="textbox required validate-alpha" id="lastName" name="lastName" type="text" style="width:260px;" maxlength="35"/></span><span class="right"></span></div>
  </div><!--fieldfrm-->
  
   <div class="fieldfrm">
  <div class="textboxfrm"><span class="label">Phone</span><span class="left"></span><span class="center"><input class="phone" name="phone" id="phone" type="text"  maxlength="15" /></span><span class="right"></span>

  </div>
  </div><!--fieldfrm-->
  
  </div>

 <div class="formrowrg">
  <div class="fieldfrm">
  <div class="textboxfrm"><span class="label"><span  style="margin-left:19px;">Address</span><span style="color:#FF9000;">* </span></span><span class="left"></span><span class="center"><input class="required" id="address" name="address" type="text" style="width:260px;" maxlength="40"/></span><span class="right"></span></div>
  
  </div><!--fieldfrm-->
 
   <div class="fieldfrm">
  <div class="textboxfrm"><span class="label"><span  style="margin-left:19px;">City</span><span style="color:#FF9000;">* </span></span><span class="left"></span><span class="center"><input class="required validate-alpha" id="city" name="city" type="text" style="width:260px;" maxlength="25" /></span><span class="right"></span></div>
  </div><!--fieldfrm-->
  
   <div class="fieldfrm">
  <div class="textboxfrm"><span class="label"><span style="margin-left:19px;">State</span><span style="color:#FF9000;">* </span></span><span class="left"></span>
  <span class="center">
  <label>
    <select id="state" name="state" class="dropboxstate" >
		<option>AL</option>
		<option>AK</option>
		<option>AZ</option>
		<option>AR</option>
		<option>CA</option>
		<option>CO</option>
		<option>CT</option>
		<option>DE</option>
		<option>FL</option>
		<option>GA</option>
		<option>HI</option>
		<option>ID</option>
		<option>IL</option>
		<option>IN</option>
		<option>IA</option>
		<option>KS</option>
		<option>KY</option>
		<option>LA</option>
		<option>ME</option>
		<option>MD</option>
		<option selected="selected">MA</option>
		<option>MI</option>
		<option>MN</option>
		<option>MS</option>
		<option>MO</option>
		<option>MT</option>
		<option>NE</option>
		<option>NV</option>
		<option>NH</option>
		<option>NJ</option>
		<option>NM</option>
		<option>NY</option>
		<option>NC</option>
		<option>ND</option>
		<option>OH</option>
		<option>OK</option>
		<option>OR</option>
		<option>PA</option>
		<option>RI</option>
		<option>SC</option>
		<option>SD</option>
		<option>TN</option>
		<option>TX</option>
		<option>UT</option>
		<option>VT</option>
		<option>VA</option>
		<option>WA</option>
		<option>WV</option>
		<option>WI</option>
		<option>WY</option>
    </select>
    </label>
  </span>
  <span class="right"></span></div>

  </div><!--fieldfrm-->
   <div class="fieldfrm_zip">
  <span class="labelzip">Zip Code<span style="color:#FF9000;">*</span></span></div><!--fieldfrm-->
  <input class="required validate-number textboxzip" id="zipCode" name="zipCode" type="text" style="width: 90px; margin-top:11px;" maxlength="5" />
  
  </div><!-- End formrowrg right-->
 
  </div><!--end of formsection1-->
  
  <div class="formheading2"></div>
  <div class="formsection">
    <div class="formrowrg">
  <div class="fieldfrm">
  <div class="textboxfrm"><span class="label">Email<span style="color:#FF9000">* </span></span><span class="left"></span><span class="center"><input class="required validate-email" id="email" name="email" type="text" style="width:260px;" maxlength="40" />
  </span></div>
  </div><!--fieldfrm-->
  
   <div class="fieldfrm">
  <div class="textboxfrm"><span class="label">Confirm Email<span style="color:#FF9000">* </span></span><span class="left"></span><span class="center"><input class="other confirmEmail" name="emailConfirm" id="emailConfirm" type="text"  style="width:260px;" maxlength="40"/></span><span class="right"></span></div>
  </div><!--fieldfrm-->
  
   <div class="fieldfrm">
  <div class="textboxfrm"><span class="label">Your UMass<span style="color:#FF9000">* </span></span><span class="left"></span>
  <span class="center">
   <label id="university_label">
    <select name="university" id="university" class="dropbox required validate-selection" style="width:260px;" >
	<option selected="selected">-- Select One --</option>
    <option >UMass Amherst</option>
    <option>UMass Boston</option>
    <option>UMass Dartmouth</option>
    <option>UMass Lowell</option>
    <option>UMass Worcester Medical</option>
    </select>
    </label>
  </span>
  <span class="right"></span>
  </div>
  </div><!--fieldfrm-->
  
    </div><!--end of left col section 2-->
	
	 <div class="formrowrg">
   <div class="fieldfrm">
  <div class="textboxfrm"><span class="label"><span  style="margin-left:19px;">Password</span><span style="color:#FF9000">* </span></span><span class="left"></span><span class="center"><input class="required validate-password" id="password" name="password" type="password" style="width:260px;" /></span><span class="right"></span></div>
  </div><!--fieldfrm-->
  

   <div class="fieldfrm">
  <div class="textboxfrm"><span class="label2">Confirm Password<span style="color:#FF9000">* </span></span><span class="center">
 <input class="other confirmPass" type="password" id="confirmPass" name="confirmPass" style="width:260px;" maxlength="30"/></span><span class="right"></span></div>
  </div><!--fieldfrm-->
  
  
   </div><!--end of right col section 2 -->
  
  
  
  </div><!--end of formsection2-->
   <div class="formsection">
  
<div class="radiocheck">
<input type="checkbox" name="termsAccept" id="termsAccept" class="validate-one-required" style="width: 1.3em; height: 1.3em;" /><span style="padding-left:7px;">I accept the <a href="terms.php" target="_blank">Terms of Service</a> and <a href="privacy.php" target="_blank">Privacy Policy</a></span></div>
   </div> 
<div class="submitfrm">
  
  <!-- <hr /> -->

<script type="text/javascript">
var valid = new Validation('registerForm', {immediate: true});
</script>
   
   <input type="submit" value="" name="Submit" id="submit" class="submit2"/></div>
  
   </div><!--end of formsection3-->
  </div><!--formlftcol-->

  <?php include("footer.php"); ?>
  

</form>
	</div><!--mainfrm -->
   </div><!--frame-->
 </div><!--footerBg-->
</div><!--back -->

</body>
</html>
